Developing and testing the feasibility, acceptability and initial efficacy of a brief peer-led intervention to improve reproductive health among women in opioid medication-assisted treatment

 描述（由申请人提供）：为治疗药物使用障碍的妇女制定有效的生殖健康干预措施，对改善妇女和儿童的健康具有巨大的潜力。在美国，近一半（51%）的怀孕是计划外的（Finer和Zolna，2014），最近一项对接受阿片类药物辅助治疗的孕妇的研究发现，比例要高得多- 86%的人将其目前的怀孕描述为意外怀孕（Heil等人，2011年）。意外怀孕的妇女最近使用药物的比例较高，几乎所有（90%）都有药物使用障碍的既往治疗史。因此，物质使用治疗方案可能是解决避孕和生殖健康问题的有希望的场所。专门侧重于预防药物使用障碍妇女意外怀孕的干预措施很少。这项研究建议使用健康信念模型（HBM; Rosenstock，1974）来指导一个简短的同伴主导的生殖健康干预的发展，将被整合到物质使用治疗环境中。此外，干预措施将特别侧重于采用长效可逆避孕方法，因为它们被认为是降低意外怀孕率的最有效方法（Trussel等人，2009年; Trussell，2012年）。通过使用混合方法，本研究将达到以下目的：1）使用形成性方法更好地了解避孕行为，并制定一个简短的同伴主导的干预措施，以防止进入阿片类药物辅助治疗的育龄妇女意外怀孕; 2）评估行为干预的可接受性，可行性和初步疗效;进行探索性分析，以确定对LARC使用影响最大的HBM结构。意向治疗分析将用于评估基线与3个月和6个月随访之间LARC使用的变化，并将检验以下假设：干预组的参与者更有可能进行计划生育随访;干预组的参与者更有可能开始使用LARC方法。第一阶段项目的长期目标是：1）可以在更大规模的第二阶段试验中正式测试的干预措施，2）加强对避孕决策和LARC摄取和使用中所涉及的HBM结构的理解。

 DESCRIPTION (provided by applicant): Developing effective reproductive health interventions for women in treatment for substance use disorders has tremendous potential to improve women and children's health. In the US nearly half (51%) of all pregnancies are unplanned (Finer and Zolna, 2014) and a recent study of pregnant women entering opioid medication-assisted treatment found much higher proportions - 86% described their current pregnancy as being unintended (Heil et al., 2011). Women with unintended pregnancies had higher rates of recent substance use and almost all (90%) had a history of prior treatment for substance use disorders. Thus, substance use treatment programs may be promising sites to address contraception and reproductive health. There is a paucity of interventions that specifically focus on preventing unintended pregnancies among women with substance use disorders. This study proposes to use the Health Belief Model (HBM; Rosenstock, 1974) to guide the development of a brief peer-led reproductive health intervention that will be integrated into the substance use treatment setting. Additionally, the intervention will specifically focus on uptake of long acting reversible contraceptive methods as they are considered to be the most effective method of reducing rates of unintended pregnancies (Trussel et al., 2009; Trussell, 2012). Through using mixed methods this study will address the following aims: 1) to use formative methods to better understand contraceptive behaviors and to develop a brief peer-led intervention to prevent unintended pregnancies among women of reproductive age entering opioid medication-assisted treatment; 2) to assess acceptability, feasibility and initial efficacy of the behavioral interventon; and 3) to conduct exploratory analyses to identify the HBM constructs that are most influential on LARC use. Intention-to-treat analyses will be used to assess change in LARC use between baseline and 3 and 6 month follow-up and will test the following hypotheses: participants in the intervention group will be more likely to follow-up with a family planning visit; and participants n the intervention group will be more likely to initiate LARC methods. The long-term goals of this Stage I project are: 1) an intervention that can be tested formally in a larger scale Stage II tria and 2) an enhanced understanding of the HBM constructs involved in contraception decision making and LARC uptake and use.